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Researchers announced the results of a muchawaited study
that showed a short course of AZT treatment effectively
reduced HIV transmission from mother to child by one half.
Hailing the results of the study, which involved 397
infected pregnant women, a "great success", a team of Thai
and US researchers said the finding could soon be translated
into global implementation <The Nation, Bangkok,
Thailand>.

Principal investigator Dr Nathan Shaffer said this is the
first conclusive scientific data that proves that AZT given
late in pregnancy reduces the risk of HIV transmission. He
said it also confirmed that transmission takes place at the
very end of pregnancy, either during labour or delivery. The
preliminary results showed women treated with the
shortcourse of AZT orally twice daily from 36 weeks
gestation until the onset of labour and then every three
hours until delivery, had a transmission rate of 9.2 per
cent, compared with 18.6 per cent in a control group which
received a placebo, he said.

Many countries found the successful AIDS Clinical Trial
Group 076 in the US four years ago was impractical due to
its long duration and comprehensive method of treatment,
with treatment costs of US$800 per person. However, an AZT
shortcourse regimen would cost $50 per person, which would
be 20 times cheaper, said Pragrom Wuthipong, Health
Permanent Secretary. BY MUKDAWAN SAKBOON and ARAYA
THAVORNWANCHAI <The Nation, Bangkok, Thailand,
19㪚㫺>.

2.
Avian flu update

From The Lancet: The H5N1 study group of The Hospital
Authority of HK, The Chinese University of Hong Kong and The
University of Hong Kong documents data on the first 12 cases
of H5N1 influenza in Hong Kong. Some of the key findings are
these:

Patients ranged from 1㫔 years of age.
Five patients had clinical or radiological evidence of
pneumonia at the time of presentation to hospital and two
others
developed pneumonic changes after hospitalisation.
Bacteria commonly associated with communityacquired
pneumonia such as _Streptococcus pneumoniae_,
_Haemophilus
influenzae_ and _Staph. aureus_ were not isolated from the
respiratory tract or blood cultures in any of the
patients.

The results of type and subtype specific rapid diagnostic
tests for detection of influenza A were compared. An
H5specific reverse transcription polymerase chain reaction
assay was the most sensitive test for rapid diagnosis. A
commercially available enzyme immunoassay (Directigen Flu A;
Becton Dickinson) was more sensitive than direct
immunofluorescence for rapid viral diagnosis of H5N1
infected patients <From: The Lancet 351:467𤯇,
1998>. In a paper (Science 279:393𤭼, 1998) describing
sequence analysis and pathogenicity studies performed by
Hong Kong, CDC, and USDA, it is demonstrated that the virus
remains lethal to chickens even after it has passed through
a human. The study raises the possibility that a few
infected people travelling beyond Hong Kong could spread it
to millions of chickens worldwide. Fortunately the evidence
still is that the virus cannot pass easily between human
beings, limiting the chances of a pandemic.

Fears the (influenzavirus A\H5N1) can be
transmitted from human to human have been rekindled after
doctors found antibodies to virus in several health workers,
health officials said on Monday. Some of them "may have been
in contact with bird flu patients". Experts have been
working to find out if persontoperson transmission is
possible. If it is the disease could be spread much more
widely <23㪚㫺, South China Morning Post>.

3.
Overview of infectious disease information

Here is our weekly summary of relevant AsiaPacific EID
issues based on postings to the ProMED Electronic Network,
which is a prototype for a communications system to monitor
emerging infectious diseases globally as an initiative of
the Federation of American Scientists (FAS) and cosponsored
by WHO. More information about PROMED can be acquired
contacting the moderator. Please contact the moderator if
you would like more any of the reports below:

ASIA

CHINA (HONG KONG) EX THAILAND  CHOLERA
12מ㫺

From HK Department of Health News Bulletin site, 12מ㫺:
There have been 7 confirmed cases of cholera cases in Feb
1998. Food histories revealed that 6 out of the 7 cases had
consumed cockles during the incubation period. The cockles
were inadequately cooked. The causative organism in all the
7 cases was _Vibrio cholerae_ O1, El Tor, Ogawa. It was
sensitive to cefuroxime, keflex and ofloxacin but resistant
to tetracycline, cotrimoxazole and chloramphenicol.

The source of the cockles was traced and found to be
imported from overseas. Wholesalers and retailers were
requested to suspend the sale of cockles. Health inspectors
made inspections in the market to ensure the advice was well
complied with. Starting from 6 Feb 1998, imported cockles
for local sale would be held and tested negative for cholera
before they were permitted for sale. This measure will be
reviewed a month later.

ACTION: John Tam, a health department spokesman said
seafood wholesalers have voluntarily suspended cockle
imports from Thailand since the government issued a cholera
alert last week. He said the government will not seek to ban
the imports, but will heighten surveillance on Thai cockles
in the future. The cholera outbreak has raised concerns
because it comes months before the summer cholera
season.

<It should be noted that WHO does not support the
embargo of goods as a means of preventing the transmission
of cholera. However, heightened surveillance and public
education are clearly appropriate.>

OCEANIA

AUSTRALIA (NEW SOUTH WALES)  CRYPTOSPORIDIOSIS (02)
02ן㫺

In New South Wales, Australia, cryptosporidiosis became
reportable by labs in December 1996. Since then, a handful
of cases (~3) were reported each month until November 1997.
From late November to February 23, 169 (159?) cases
were reported. 53% were female, and mean age was 4 years.
Cases were spread widely across the state. Extensive
interviews with the NSW cases about exposures (travel,
commercial products or drinking water, animals, child care
etc) during the 2 weeks before onset identified no common
risks, although 51% reported contact with other people with
diarrhoea, and 61% reported swimming (but at a variety of
different pools and beaches across the state).

While the case increase over summer could represent
seasonal patterns, the NSW Health Department has issued
several warnings and recommends that persons with diarrhoea
practice good hand washing, and stay out of child care, and
avoid entering swimming pools until completely recovered.
Investigations continue.

AUSTRALIA (NEW SOUTH WALES)  PARAMYXOVIRUS, PIGS
(02)
25מ㫺

Dr Peter Kirkland, Elizabeth Macarthur Agricultural
Institute in Camden (Australia), recently told a
forum on human disease that the discovery of a paramyxovirus
in pigs which also affected Australian farm workers last
year should serve as a warning to government not to cut back
funds for veterinary laboratories, and that the virus also
raised questions about the potential hazards of
transplanting pig tissue into humans. Kirkland was further
cited as saying the affected farm, close to Sydney, was
still in quarantine nearly a year after paramyxovirus caused
stillbirths and deformities in pigs and made two workers
seriously ill with flulike symptoms. Kirkland added: "If
farmers are discouraged from bringing in their sick animals
we run the risk that a number of these diseases will remain
concealed." Kirkland's research, showing that the
measleslike virus probably sprang originally from fruit
bats, will shortly be published in the US Center for Disease
Control's journal, Emerging Infectious Diseases.

AMERICAS

CANADA  SCRAPIE
22מ㫺

Source: ANIMALNET (D. Powell, Univ. Guelph) & Bovine
Spongiform Encephalopathy: An outbreak of scrapie has,
according to this story, forced the Canadian federal
government to slaughter almost 5,000 sheep in Quebec over
the past 14 months. The story adds that while government
officials played down the publichealth impact, saying
scrapie poses no proven risk to humans, the outbreak has had
a dramatic economic impact on some cash strapped
farmers.

USA (WASHINGTON)  E. COLI 0157:H7 INFECTIONS, HUMAN
26מ㫺

Seven children who attend a day care center in Spokane,
Washington are reported to have suffered from _E. coli_
O157:H7 infections in recent days. Investigators have not
yet identified the index case, or a common source for the
outbreak. An additional case reported from the same locality
has been confirmed by DNA typing of bacterial isolates, but
appears to represent an early case from a recovered patient
rather than an indication that the outbreak is spreading.
All patients are either recovered, or out of imminent
danger.

EUROPE

BSE, MEAT HYGIENE RULES  EUROPEAN UNION
24מ㫺

EU hygiene rules to be waived in 'BSE free' states By
Toby Helm in Brussels and David Brown GERMANY and seven
other EU nations could be given official "BSE free" status
as part of a plan to help break the deadlock over the
British beef ban. The idea  being discussed by the European
Commission and the British EU presidency  would involve
waiving proposed new meat hygiene rules for countries which
have had no cases of mad cow disease in domestically bred
cattle. The plan follows warnings by the Bonn government
that it will oppose moves to ease the ban on British meat
unless Germany is exempted from the new scheme.

An agreed list of banned beef parts is supposed to be in
place by April 1, but Germany has made it clear it does not
expect to be penalised for a mad cow outbreak in another
member state. It is leading calls from the nonBSE nations
to be exempted from any restrictions agreed by EU experts
and the Brussels Commission. With no hope of reaching an
EUwide deal, the commission is believed to be planning a
twotier system, with tougher measures against countries
with a record of BSE. Britain has the worst record but now
has the toughest hygiene controls as a result  and
exclusion from the terms of any ban for the rest. <It
would be interesting to know if colleagues might have found
such policy practical for the APEC region, for example, if
the Avian Flu epidemic had been more widespread.>

ANIMAL DISEASES, EPIDEMICS: CONTAINMENT  EUROPE
25מ㫺

Europe faces "devastating" animal disease epidemics in
the future and should alter its strategy for containing
them, the United Nations Food and Agriculture Organization
warned Tuesday. The FAO blames European livestock disease
epidemics on the dense populations of livestock and an
increase in longdistance animal transportation as trade
increases.

The agency has called for a cut in herd concentrations,
an increase in border controls, and the development of
animal identification systems. It also suggested the private
sector be obliged to take on some of the costs of containing
diseases and warned governments that the privatization and
decentralization of national veterinary services could
reduce their effectiveness. The agency's recommendations are
aimed at containing fast spreading diseases such as swine
fever and foot and mouth disease, rather than the BSE "mad
cow" disease, which develops more slowly.

In a report Tuesday the FAO challenged the practice by
which the public sector in Europe bears the cost of
epidemics and compensates the private sector for losses
incurred. It argued this did little to encourage sanitary
methods. "Industry does not appear to be able to discipline
itself and it may be that government compensation instills
false security." The FAO suggests a compulsory insurance
program for livestock owners to protect against the costs of
disease. It said certification and identification of animals
were essential for their safe movement.

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tb@mos.com.np

This meeting will be a discussion of the initiative for
APEC cooperation in emerging infectious diseases. Delegates
from health backgrounds or related to the Ministry of Health
are especially needed for input, but discussion will be at a
level appropriate for nonhealth specialists to participate
in a valuable way. Some of the areas of cooperation we will
discuss: didactic information, exchange of surveillance on
selected diseases, resource access to libraries,
educational/distance learning, and training. Attendance must
be coordinated through each science and technology
delegation, so please contact the lead of your Science and
Technology delegation.

MAJOR TOPICS: current work on surveillance, epidemiology,
research, communications and training, and prevention and
control of emerging infectious diseases as well as topics
related to emergency preparedness and response. Onsite
registration will be available. The registration fee is
$200. For more information contact the moderator or check
the site http://www.cdc.gov/ncidod/eidann.htm

The APEC EINet listserv was established to enhance collaboration among academicians
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